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I'm newly diagnosed, have been on a trial machine for a week (ResMed S9). I was given three masks to try: pillows, nose only, and full face.

It seems like I have been pretty lucky so far. In my sleep study I had an API of 73 (not a typo), stopped breathing at one point for 2:16, and had almost no REM sleep.

My initial pressure setting is 7. When the person fitting me for masks said to try pillows since they were most comfortable I said I was a mouth breather and so not much point. She said that usually stops with CPAP. She was right, the pillows work fine for me, my API dropped down to about 3, and I had a dream.

I sleep well with the pillows but my nose is a bit sore from the pressing, how long does it take for the nose to toughen up? Weeks, months?

I don't think the mask is over tight, but if my nose does not get comfortable in a bit, I'll consider loosening straps and watch leakage.

I figure I should try a mask that goes over the mouth and have it as a backup for times when my nose is clogged. Is that a common approach?

Sore nose? Loosen the straps! The straps are there to keep the mask in place and NOT to push pillows up your nose.

Everything I post on this board is nothing more than an opinion expressed by an apneak. Normally, it's based on facts and experience but sometimes, I may get things wrong or not have all the facts.
I reserve the right to change my mind. Why? Because tomorrow I may know better.

Wish I could remember the name of the product, maybe someone here can remember it. There is a product that new mothers use to desensitize the ah area where a baby feeds. It is a cream found in the baby area of the drug store. It of course can be used to desensitize anything and this has been known to help.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

One size larger is a common fix, as is loosen the straps (or stretch them if P10). Also important is hygiene - clean your nose well, use saline/xylitol sprays before bed time, oil or another spraying in the morning, wash the pillows after every use.

I had two kinds of soreness when I first started with nasal pillows. One kind was from skin irritation and the other was from pressure on my upper lip, gum, and nose.
Skin irritation: just before putting on the mask, I used zinc oxide ointment for a minor sore that developed just inside my nostril. That sore cleared up in a few days. The ointment washes off the mask each morning with a bit of soap and rubbing. I also developed slight skin irritation around my nostrils - I guess from a small amount of shifting of the mask during the night. As mentioned in other replies a small amount of lanolin helps with that. I used the lanolin mainly as a lubricant to prevent irritation while wearing the mask. After a few weeks my skin toughened up so I no longer have sores or irritation and no longer need the ointments.

Pressure soreness: contrary to other replies, I got relief by switching to a smaller mask; from large to medium. I started with the large mask because of its greater, more comfortable, air flow. But over the course of a month or two I noticed an increasing numbness of my lip and gum and a feeling like my nose was pushed up throughout most of the morning. Loosening the mask didn't help - it was as loose at the Airfit P10 strap would go, even when using a chin strap to help ease the tension of the mask strap. (My CPAP pressure is only 6.6). So out of desperation I tried the medium mask. In a short time I got used to the slightly lower air flow (and increased noise) and the numbness and squished nose sensations are gone.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.